Role overview

Qualifications

2–5 years of experience in workers’ compensation claims handling, bill review, or negotiation (or equivalent combination of education and experience).
Strong knowledge of workers’ compensation regulations and fee schedules.
Strong understanding of medical billing codes (CPT, ICD-10, HCPCS), state fee schedules, and PPO discounts.
Excellent communication and negotiation skills, both written and verbal.

Responsibilities

Review and analyze medical bills, treatment records, and claim documentation to determine appropriate settlement values.
Negotiate with medical providers, and other parties to reach fair and timely resolutions.
Ensure compliance with all applicable state workers’ compensation laws and regulations.
Maintain accurate and up-to-date documentation of negotiations and outcomes in the claims management system.

Key facts

Remote from: Canada, California (USA), United States
Full time
Mid-level (2-5 years)
English

Hard skills

Medical Billing Workers' Compensation Claims Workers' Compensation Claims Cost Containment Claims And Litigation Management Settlement

Other skills

Microsoft Office
Professionalism
Analytical Skills
Time Management
Detail Oriented
Verbal Communication Skills

About the company

MedRisk

Digital Health & Health Tech

MedRisk is the leading provider of managed physical medicine for the workers’ compensation industry and related market sectors. Unified through a uniquely integrated, US-based support model, we pride ourselves in combining clinical expertise with highly personal service and responsiveness. This focus allows us to offer distinct value to each stakeholder in the workers’ comp process – carriers and TPAs, employers, adjusters and case managers, physicians, network providers and the patients themselves. In short, we’re here for you; at MedRisk, you’re never just a number – you’re an individual who deserves a solution tailored to your exact needs. We’re here to help you reach your goals and improve your outcomes – whatever they may be.

Company details

IndustryDigital Health & Health Tech

Company size1001 - 5000

Links

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Job description

Job Title: Negotiation Specialist (Technical Operator III)

Department: IQ Analysis
Reports To: IQ Analysis Manager
Location: Remote
Job Type: Full-Time

Job Summary:

The Negotiation Specialist is responsible for evaluating, negotiating, and settling workers’ compensation claims in compliance with applicable laws and internal policies. This role involves working closely with providers, adjusters, and internal teams to ensure cost-effective and fair outcomes while maintaining a high standard of service.

Key Responsibilities:

Review and analyze medical bills, treatment records, and claim documentation to determine appropriate settlement values.
Negotiate with medical providers, and other parties to reach fair and timely resolutions.
Ensure compliance with all applicable state workers’ compensation laws and regulations.
Maintain accurate and up-to-date documentation of negotiations and outcomes in the claims management system.
Identify potential cost-saving opportunities and work toward minimizing claim exposure.
Communicate clearly and professionally with both internal and external contacts.
Monitor claims to identify trends and report on potential areas of concern.

Qualifications:

2–5 years of experience in workers’ compensation claims handling, bill review, or negotiation (or equivalent combination of education and experience).
Strong knowledge of workers’ compensation regulations and fee schedules.
Strong understanding of medical billing codes (CPT, ICD-10, HCPCS), state fee schedules, and PPO discounts
Excellent communication and negotiation skills, both written and verbal
Strong attention to detail and ability to manage multiple cases independently
Excellent negotiation, communication, and analytical skills.
Ability to work independently and manage multiple priorities in a fast-paced environment.
Proficient with claims management systems and Microsoft Office Suite.

Preferred Qualifications:

Experience in a TPA, insurance carrier, or medical cost containment company